Friday, April 01, 2005

Issues at the end of life

This reflection is admittedly connected to the case of Terri Shavio. I have refrained from comment as her case unfolded for a variety of reasons: distaste the politicking and posturing that seemed to surround this case of human suffering, a sense that I could not know enough concerning Terri's condition nor the entire situation to comment on this particular case in an informed manner, and lastly a sense that I would simply be adding to the circus quality that is any case that gains media attention.
Terri has died, may she rest in peace. And I think now is the time to reflect on what was at stake in her case and why to some degree the wrangling, the posturing, the media circus was legitimate, even if distasteful.
In some ways I, having served as a chaplain for one unit of CPE, have been with families that have had to make choices concerning life support. As Tripp has pointed out families struggle with end of life decisions all the time, in the hospital it is common place. Now, in my limited experience of six months of chaplaincy the questions were not primarily surrounding the removal of feeding tubes. Those taken off life support died in minutes or at most hours (I had three such cases during my time as chaplain, my fellow CPE chaplains had about the same amount during that time). Thus, in the cases I encountered in the hospital it was in fact the artificial support of life of a body that was dying and most likely could not or would not recover. It usually included the removal of IVs and fluid sustenance but that was never the main form or sole form of life support being provided.
What these experiences lead me to was and many other experience in the hospital was to the realization that the medical profession is often so focused on the preservation of life that it at times oversteps its actual abilities, and then I as chaplain was called into deal with medical failure.
In some ways our culture worships life. We want medicine to keep us alive as long as possible. But not really, and this is where the "right to die" enters the picture. We expect medicine to keep us alive in a state we would want to live. We want our loved ones to be restored to full and complete functioning. When medicine fails to give us its promise of life to the fullest (as we understand it or wish it to be) it is traumatic for all, and as often as not the physicians (at least in my experience) shrink away and call in the chaplain. Thus it was difficult to convince people that when I showed up next to their hospital bed that I was not coming as a messenger of death. We want medicine to keep us alive, but we balk at the common results that being kept alive often means being incapacitated, at times severely so. Then we want the medical establishment to serve death rather than life.
What I am trying to get at is that our technology, our desires and our worship of life (as opposed to the author of life) leads our culture to the sort of crisis we have seen manifested in Terri Shavio's case. We in fact cannot correctly discern what is the correct thing to do, and these are agonizing because medical technology and science cannot provide us with the answers to the questions of how we should let people die. Even that phrase "how to let people die..." should strike us as odd and a product not of life but of a certain technology and ideology.
It was agonizing working in the hospital, death lurked in our technologies of life, and few were willing to face that. And as often as not it wasn't the decision of families or medical professionals that kept people alive or allowed them to die. One of the things I found most necessary as a chaplain was to lead people in the hospital to let life and death be a mystery, something beyond our control and manipulation. Yet, that was at odds with the science and technology of medicine, which precisely exists to manipulate and control. Now, I did encounter physicians and nurses who would enter into the mystery and recognize the limits of human ability to control our life or our death. Yet, to do so was to resist the implicit ideology of the hospital and medical technology, that life and death are under human control.
"Right to die" is simply another label for that ideology that we control our life and our death. As a Christian I must say, as a pastor I must say that this ideology of control is a lie. What ever should have happened in the case of Terri Shavio, our confusion over end of life or the continuing of her life is at bottom the result of our cultures belief that our medical technology has given us control over life and death, and that we are the ones who decide life and death: that is we have declared ourselves through our technology to be God.